Descriptors: Antihypertensive agents – pharmacology; Anti-inflammatory agents – pharmacology; Drug interactions
Summary. Interactions between antihypertensive agents and nonsteroidal anti-inflammatory drugs (NSAIDs) are often seen in clinical practice. Inhibiting the renal synthesis of vasodilatory prostaglandins and enhancing salt and water retention, NSAIDs increase blood pressure, particularly in hypertensive subjects. Not all NSAIDs are equal in this respect: the highest elevations in mean arterial pressure are reported with indomethacin, naproxen, piroxicam and rofecoxib, while low-dosed aspirin, cele- coxib and ibuprofen, are less unwelcome in this respect. The same is true for the antihypertensive drugs: the most prone to the interaction (worsening of blood pressure control) are diuretics and ACE inhibitors, and the most resistant seem to be the calcium channel blockers. Although these claims must be corroborated by further clinical investigations, one of which is under way in Croatia, coprescription of antihypertensives and NSAIDs, particularly to the elderly, in addition to vigilance and care, requires operative knowledge of the therapeutic options.

Descriptors: Arthroplasty, replacement, knee – methods; Knee prosthesis
Summary. Development of mini invasive techniques for implantation of unicondylar knee prostheses has increased general interest in this type of surgery. Indications are single compartment arthrosis, patients over 50 years of age with total body weight of less then 80 kg with small axis deviations and ligaments preserved. Important contraindications are systemic diseases. Authors present mid term postoperative results for 25 patients and 26 knees after implantation of unicondylar knee prosthesis type Repicci. Average age at time of surgery was 64.3, predominantly women and in all patients varus deformity with medial compartment arthrosis was seen. According to the Ahlback classification patients were from type 1 to type 4. Average follow up was 31.8 months. We achieved good axial correction with femorotibial angle of 6.2 degrees postoperatively, with flexion of 118 degrees and only in 3 knees extension lag was seen of an average of 8.3 degrees. According to the Knee Society Questionnaire, knee score was 60 points preoperatively and 86.8 points postoperatively and functional score was 30.9 points preoperatively  and 71.1 points postoperatively. Pain level, according to the Visual Analogue Scale, was preoperatively 6.8 points and 2 points postoperatively (10 was max). We conclude that the unicondylar knee arthroplasty is a good solution for patients with early degenerative changes in one knee compartment. This type of operative procedure will be more used because of numerous advantages when compared to other treatment options.

Descriptors: Emergencies; Orthopedics; Outpatient clinics, hospital
Summary. The aim was to analyse priority referrals from the general practitioner to the specialist in the orthopaedic outpatient clinic. The analysis was conducted during two weeks in 2005. Besides general data and procedures conducted by the ortho- paedic surgeons, the adequacy of the priority referral was acquired. 21.9 outpatients were daily examined and they suffered mostly from low-back pain (39%), followed by knee (20%), hip (12%), and shoulder (11%) problems. The priority referral was inadequate in 57% of cases. The X-ray imaging was conducted in 33% of cases, while an intake of oral analgesics was advised in 67% and physical therapy in 73% of the visits. The number of inadequate priority outpatients at the orthopaedic clinic was very high. They could either wait for a scheduled appointment or could be further treated by the general practitioner, as most of the conducted procedures are available at the primary health-care level.

Descriptors: Emergencies; Forearm – surgery; Elbow – surgery; Hand – surgery
Summary. Functional ability of a hand determines person’s creative and social abilities. Thus any functional inability of upper limb causes huge unfavourable, practical and economic, consequences for both an affected person and the whole community. The goal of treating affected upper limbs is to restore their function. Subsequently, identification of urgent and relatively urgent pathology of an upper limb and early diagnostics and treatment are of great importance because belated, secondary and recon- structive surgical procedures achieve significantly poorer results. Identifying pathology of an upper limb requiring urgency, leading us towards early diagnostics and timely treatments, functional restoration of upper limbs and enable prevention of permanent consequences.

Descriptors: Knee joint – surgery; Emergencies
Summary. Anatomy of the knee joint is one of the most complicated when compared to other joints in the human body. Due to high demands and strong forces acting on the knee joint, it is also one of the most injured joints. Every structure in the joint can be damaged and some of the damages demand earlier treatment. Except intraarticular fractures, stress fractures of the proximal tibia, as a result of lower extremity malalignment, need earlier treatment to prevent the dislocation of the fragments. Damage to the articular cartilage needs earlier treatment due to its tendency to involve wider area of the joint. Meniscus rupture is not an indication for earlier treatment, except a »bucket handle« rupture due to its potential to block the movements of the knee joint. Collateral ligament injury needs early treatment to prevent chronic laxity of the joint. Anterior cruciate ligament early recon- struction in top athletes results in their complete rehabilitation and return to the previous level performance. Total knee replace-ments may result in a number of complications, some of which need prompt treatment. Septic arthritis is a condition that requires prompt treatment, without any hesitation. Failure of earlier or prompt treatment of the conditions of the knee men- tioned in this chapter may result in permanent damage to the knee joint.

Descriptors: Bone neoplasms – diagnosis, surgery
Summary. Tumours of locomotors system regardless whether they are primary or secondary, malign or benign, are regarded as urgent conditions in orthopaedics. The goal is early identification, urgent processing and diagnosing within as short period of time as possible in order to start the appropriate treatment. Since such tumours are most common in childhood and with teenagers, when anamnesis and clinical data cannot be specific and they are various, it is an imperative to identify and diagnose them early.